DMERC

CodeCheck DMERC (Durable Medical Equipment_ can be used to check many of the relationships when you are submitting claims involving durable medical equipment items. You can check code validity, diagnoses, and DMERC-specific medical necessity results. Your search form is formatted like the UB04 print form, and your search results are returned in order of procedure relative weight.

Perform a DMERC CodeCheck

Use this procedure to check code validity, diagnoses, and DMERC-specific medical necessity results for claims that involve durable medical equipment items.

Procedure

Select CodeCheck > DMERC. The DMERC Input page opens.
Select a Date of Service.

Note: The date of service that you select will automatically populate in the first line item Date of Service field.

Select a Diagnosis of ICD-9 or ICD-10.

Note: When you select a date of service that is before the ICD-10 cutover date of October 1, 2015, the ICD radio button automatically defaults to ICD-10.

Choose a Default State or verify the default state is entered correctly.
Verify or select a Default Payer.

Note: Payer defaults to the assigned Payer for the State selected.

Enter the Date of Birth. (This step is optional, but recommended).

Note: Providing a date of birth allows KnowledgeSource to flag age-related issues on your claim. If you type the date into the field, please use the date format YYYY-MM-DD.

Example: 1962-11-14

Select the patient’s Gender. (This step is optional, but recommended).

Note: Providing the gender allows KnowledgeSource to flag gender-related issues on your claim.

Type a CPT/HCPCS code. Up to 10 rows are supported.
Type any Modifiers assigned to the procedure (not required). You may enter up to 3.
Type a Revenue Code for each CPT/HCPCS code (not required).

Note: Remember to include any leading zeros with the Revenue Code.

Enter the Date of Service.

Note: The date of service defaults to the date as indicated in the Date of Service field on the toolbar. If you manually change the date in the form, please use the date format YYYY-MM-DD. You may see a warning message if your manual change to the Date of Service produces a different payer than the Default Payer, to make you aware of the impact of the change.

Type the Primary ICD-9 or ICD-10 diagnosis code.
Type any Secondary ICD-9 or ICD-10 diagnosis codes. You may enter up to 18 additional codes.
Click Submit.

View DMERC CodeCheck Results

Refer to the field description table for descriptions of each icon and what information they describe.

Field Descriptions

The following table describes the fields in your search results for CodeCheck DMERC. Not all fields may be relevant to your particular search.

Field	Description
HCPCS Code	Indicates the code is valid. Indicates the code is valid but expired. Indicates there is an add-on code; these codes cannot be billed on a claim without a second specific code. Displays when there are "see also" codes linked to this code.
Weight	Shows payment weight when it is > O.
Modifiers	A check indicates a valid CPT/Modifier pairing. An exclamation point indicates an invalid pairing.
Revenue Code	Displays as valid or invalid. When the Revenue Code is valid, a hyperlink takes you to the code details page.
HCPCS Description	A description of the CPT/HCPCS code.
ICD-9 Column Indicators
	Indicates a valid code.
	Indicates an additional digit required.
	Indicates a Manifestation Code.
	Other Specified Code
	Unspecified Code
Field	Description
ABN	Indicates the need for an ABN based on the CPT/HCPCS - ICD-9/ICD-10 pairing: Yes - ABN is required. No - ABN is not required ? - You have entered codes that may require an ABN, but will depend on additional policy validations. Click the policy link or policy advice icon for more details.
APC	If the CPT/HCPCS is payable by APC, the APC code is shown, and is a link to code details.
HCPCS Notes	Click the icon to open any notes associated with this CPT/HCPCS.
User Defined Edits	Appears if your clinic has any user-defined edits for the code combination. Indicates your edit defines this pair as meeting medical necessity. Indicates your edit defines this pair as not meeting medical necessity. Indicates you have no defined medical necessity condition for this pair.
DME Edits
DME Edits	Shows DME policy matches for your HCPCS/ICD-9, ICD-10 Payer combination. If a policy reference is found, an "L" will appear, which opens a new tab containing policy details.
	No LCD/NCD Policy found.
	CPT/HCPCS was found in an LCD, but may not directly relate to coverage.
	Policy has a high probability of being unrelated to your HCPCS/ICD-9 pair.
	ICD-9/CPT match found in LCD database; also shows with valid E&M codes
	ICD-9/CPT match found in LCD database; also shows with valid E&M codes, and includes FinThrive advice.
	Possible Medical Necessity issue. Click on the yellow dot for details.
	Possible Medical Necessity issue. Click on the yellow dot for details, and includes FinThrive advice.
	ICD-9/CPT linkage contradicts a policy in the LCD/NCD database, or the combination is excluded or not covered.
	CD-9/CPT linkage contradicts a policy in the LCD/NCD database, or the combination is excluded or not covered, and includes FinThrive advice.
	Codes Medicare will never cover.
	Codes Medicare will never cover, and includes FinThrive advice.
Age/Gender	Any age or gender issues applicable to the CPT/HCPCS code or any ICD-9 or ICD-10 on the claim is indicated at the bottom of the CodeCheck results Shows for any codes with gender or age edits if there is no age or gender specified on the claim. Shows for any codes that conflict with a specified age or gender.